Organization
GATEWAY HEALTH SYSTEMS, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AJIBOLA A AYENI PHD, MD (ADMINISTRATOR)
(708) 754-9674
Entity
Organization
Contact information
Practice address
222 VOLLMER RD, CHICAGO HEIGHTS, IL 60411-1664
(708) 754-9674
Mailing address
2902 ALEXANDER CRES, FLOSSMOOR, IL 60422-1704
(708) 754-9674
(708) 754-9796
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
1010178
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1010178
STATE AGENCY LICENSE NUMB
IL
Enumeration date
10/19/2006
Last updated
08/22/2020
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